Analysis of the risk factors for the development of post-operative spinal epidural haematoma

Awad, J.; Kebaish, Khaled M.; Donigan, Jonathan A; Cohen, David B.; Kostuik, John P.

doi:10.1302/0301-620x.87b9.16518

Cited by 206 publications

(241 citation statements)

References 33 publications

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“…It is conceivable that spinal/epidural hematoma may occur in anticoagulated patients who are receiving regional anesthesia or analgesia. However, a recent study found that well-controlled anticoagulation was not associated with an increased risk of postoperative spinal/epidural hematoma [89]. …”

Section: Risk-reduction Interventionsmentioning

confidence: 99%

Pre-operative pulmonary assessment for patients with hip fracture

Siu

Tse

et al. 2010

Osteoporos Int

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Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.

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Section: Risk-reduction Interventionsmentioning

confidence: 99%

Pre-operative pulmonary assessment for patients with hip fracture

Siu

Tse

et al. 2010

Osteoporos Int

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“…The quoted incidence of postoperative symptomatic epidural hematoma occurring after all spinal procedures requiring surgical intervention ranges from 0.2% to 2.9% [1,6,13]. Closed-suction drainage is believed effective in preventing these complications in spine surgery, but only a few studies have addressed the Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Section: Introductionmentioning

confidence: 99%

Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Kanayama

Oha

Togawa

et al. 2010

Clinical Orthopaedics &Amp; Related Research

101

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Background Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications. Questions/purposes We evaluated the efficacy of closedsuction drainage in single-level lumbar decompression surgery. Patients and Methods We retrospectively reviewed 560 patients who underwent single-level lumbar decompression or discectomy. We routinely used closed-suction drainage in all spinal surgeries until July 2003, and thereafter, we did not use drains in single-level lumbar decompression surgery. These two groups (298 patients in the group that received drains, 262 in the group that did not receive drains) were compared for rates of wound infection and epidural hematoma. Results Mean operating time (55 versus 56 minutes) and intraoperative blood loss (64 versus 57 mL) were not different between the two groups. None of 560 patients had a wound infection requiring surgical intervention. The rate of postoperative hematoma was 0.7% in the group that received drains (two of 298 patients) and 0% in the group that did not receive drains (zero of 262 patients).Conclusions In this study, the risk of wound infection and hematomas in single-level lumbar decompression surgery was not influenced by use of a drain. The use of postoperative wound drainage in patients with potential risk for epidural bleeding in situations such as multiple-level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases needs additional study.

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“…Postoperative epidural hematoma as an early complication after decompression in lumbar stenosis occurs with a prevalence of 0.1-0.2% [1][2][3][4]. Magnetic resonance imaging (MRI) is recommended in patients with postoperative increasing pain and new neurological symptoms to rule out hematoma.…”

Section: Introductionmentioning

confidence: 99%

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

et al. 2010

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Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176 mm 2 in asymptomatic patients and 365 mm 2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0 mm 2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5 mm 2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75 mm 2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75 mm 2 in early postoperative MRI was found to be the threshold for clinical significance.

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Analysis of the risk factors for the development of post-operative spinal epidural haematoma

Cited by 206 publications

References 33 publications

Pre-operative pulmonary assessment for patients with hip fracture

Pre-operative pulmonary assessment for patients with hip fracture

Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

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